Provider Demographics
NPI:1245791789
Name:HOLTH, LORI LEA
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LEA
Last Name:HOLTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-4831
Mailing Address - Country:US
Mailing Address - Phone:256-390-6381
Mailing Address - Fax:
Practice Address - Street 1:5820 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-4831
Practice Address - Country:US
Practice Address - Phone:256-390-6381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical